Medical Authorization Assistant (Prior Authorization)

  • CalOptima
  • 505 City Pkwy W, Orange, California
  • Mar 08, 2024
Full Time Human and Social Services Public Health

Job Description

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Medical Authorization Assistant (Prior Authorization)

Job Description
Department(s): Utilization Management (Prior Authorization)
Reports to: Supervisor Utilization Management
FLSA status: Non-Exempt
Salary Grade: C - $43,281 - $61,798

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Thursday, February 22, 2024 at 11:59 PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

About CalOptima Health

Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health!

About the Position

The Medical Authorization Assistant (Prior Authorization) will provide office and referral management services and serve as a contact between members, physicians, providers and CalOptima Health staff. The incumbent will process initial intake of information, assist with authorization functions and gather information. The incumbent will be responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities and ancillary providers. The incumbent monitor tasks related to CalOptima Health's prior authorization and referral process. Additionally, the incumbent will be responsible for applying CalOptima Health's medical criteria and policies/procedures to authorization or referral requests from medical professionals, clinical facilities and ancillary providers. The incumbent will directly interact with provider callers, acting as a resource for their needs. The incumbent will operate under the direction of the licensed nurse.

Duties & Responsibilities:
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Receives referral requests via fax, phone or electronically and enters new service request information into the authorization system.
  • Collects additional information from CalOptima Health members and providers to complete referral information.
  • Authorizes requested services according to CalOptima Health's authorization guidelines, performing data entry into the authorization system and verifying eligibility.
  • Contacts the health networks and CalOptima Health Customer Service regarding health network enrollments.
  • Assists the Medical Case Managers in gathering medical records, obtains appropriate coding for diagnosis and procedures and follows up on phone calls as directed by the authorization nurse.
  • Documents all contacts and case information in the system using the standard charting format.
  • Performs data entry into the appropriate databases for monitoring, tracking and trending of events and other relevant databases as needed.
  • Completes other projects and duties as assigned.


Experience & Education:
  • High School diploma or equivalent required.
  • 2 years of experience in a health care or managed care setting required.
  • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.


Preferred Qualifications:
  • Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
  • Prior Authorization and Utilization Management process experience.


Physical Demands and Work Environment:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Physical demands: While performing duties of job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes or laptop case, up to 25 pounds. Employee must be able to communicate, particularly for regular phone use, in meetings, face-to-face interaction and while presenting.


  • Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.


About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.



CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.



If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.


Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4540







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Job Address

505 City Pkwy W, Orange, California 92868 United States View Map